Provider Demographics
NPI:1720310287
Name:INDANA, VEERA V
Entity Type:Individual
Prefix:
First Name:VEERA
Middle Name:V
Last Name:INDANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102A BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-7729
Mailing Address - Country:US
Mailing Address - Phone:718-485-3300
Mailing Address - Fax:718-485-3301
Practice Address - Street 1:102A BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7729
Practice Address - Country:US
Practice Address - Phone:718-485-3300
Practice Address - Fax:718-485-3301
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist